Skin Cancer Screening Not Enough to Solve Racial Disparities in Melanoma Diagnosis

Alternative approaches to routine skin cancer screening in patients of racial and ethnic minority groups may help improve disparities in melanoma outcomes, according to research published in JAMA Dermatology.¹

Although rates of melanoma are higher among non-Hispanic White individuals, people of color are much more likely to die from the disease. Research has shown that the 5-year survival rate for people of color with melanoma is 70%, compared to 92% in non-Hispanic Whites.²

“In this study, we asked whether screening could address this disparity by helping detect melanoma early,” Laura Ferris, MD, PhD, lead author on the study, said in a release.³ “Our findings suggest that regular skin checks are not the answer, but that doesn’t mean that we should be offering less care or that our work is done.”

Investigators from the University of Pittsburg Medical Center conducted a study to examine the characteristics of melanoma detection in a large racial and ethnic minority cohort. The data was gathered from a previous study which examined the incidence of melanoma among individuals who participated in a primary care–based quality initiative from 2014 through 2018.

The study cohort included 60680 patients who self-reported as Hispanic, Asian, black, American Indian, Alaska Native, or Pacific Islander. Among those, 12738 were screened for skin cancer by a primary care clinician, and 47942 were not.

Investigators found that 8 melanomas were diagnosed among the study cohort, with 3 being in screened and 5 in unscreened patients. Only 1 melanoma was identified during a skin cancer screening, while 3 were found by the patient or their family. Additionally, 4 melanomas were identified by a health care professional during a visit for reasons other than a skin screening.

The researchers determined that over 12,000 screenings would need to be done to identify 1 case of melanoma in racial and ethnic minority populations. In comparison, the investigators previously reported that only 373 White individuals would need to be screened to find a case of melanoma.

“This is an almost unfathomable number of doctor’s visits to find one melanoma,” Ferris said. “Rather than screening everyone, educating physicians about presentation of melanoma in skin of color, educating the public about their risk of melanoma and making sure that people have access to a dermatologist when they have a suspicious lesion could be more effective in improving early detection.”

Study limitations include a nonrandomized study design, limited follow-up, a relatively small proportion of racial and ethnic minority individuals, a patient population that may not reflect the sociodemographic makeup in other geographic areas, and a study population consisting exclusively of patients with a primary care clinician.

References

1. Smith B, Matsumoto M, Wang H, et al. Melanoma Detection in Alaska Native, American Indian, Asian, Black, Hispanic, and Pacific Islander Patients in a Large Skin Cancer Screening Initiative. JAMA Dermatol. Published online July 26, 2023. doi:10.1001/jamadermatol.2023.2067.

2. Gupta AK, Bharadwaj M, Mehrotra R. Skin Cancer Concerns in People of Color: Risk Factors and Prevention. Asian Pac J Cancer Prev. 2016;17(12):5257-5264. doi:10.22034/APJCP.2016.17.12.5257

3. Screening Won’t Solve Racial Disparities in Melanoma Outcomes, Study Suggests. University of Pittsburgh. July 27, 2023. Accessed July 28, 2023.